USDA Revision 9 Nutrition Risk Factors - Effective April 14, 2008:
USDA has approved a new allowable risk criterion and updated two other risk criteria:
· New risk factor #904 Exposure to Environmental Tobacco Smoke (ETS);
· Updated risk factor #371 Maternal Smoking; and
· Updated risk factor #340 Nutrition Related-Risk Conditions.
Updated risk factor #340 Nutrition-Related Risk Conditions was affected as a result of changes to risk factor #348. In Missouri, all of the USDA nutrition-related risk conditions #341 through #362 are currently incorporated into the overall risk factor #340.
ER#2.04450 which included risk criterion for risk factor #300 (Z1) Pregnancy Induced Conditions and risk factor #340 (Z3) Nutrition-Related Risk Conditions was separated into two individual policies to allow easier updating of risk factors. Please see the attachments regarding additional clarification. Print these attachments and keep them on hand as they will supersede the 2006 WOM policies until the 2008 WOM is available.
Making revisions linked to Revision 9 led to minor changes in several other policies. Risk factors #371 and #904 will be automatic risk factors assigned, dependant upon responses to the questions in the computer system and on the WIC-1 and WIC-2. Information highlighting changes to the computer system and WIC-1 and WIC-2 forms is included in the attached document.
The Nutrition Coordinator is responsible for providing training to all LWP staff on Revision 9 materials during the months of March and April 2008 utilizing attached materials. Beginning in March 2008 the State agency will incorporate Revision 9 information in the WIC Basic Orientation training for trainees.
If you have questions regarding these risk factors or information, please contact your district nutritionist for technical assistance.Note: Please return the "Acknowledgement Sheet" indicating you have received this notification. FOURTEEN ATTACHMENTS

February Caseload: The month of February showed a slight dip in caseload (to 140,181) as is expected, however, the dip was much less than what we have experienced in previous years. Please see the caseload graph. Our caseload for FY 2008 is averaging a little over 140,400. Average caseload in FY 2007 was 134,600. This is about a 4% increase in caseload from 2007 to 2008. We recognize that agencies are working feverishly to see all the new participants; we thank you for your dedication and passion in providing services to those in such great need. Any caseload questions can be directed to your district team or Jim Schinder at James.Schindler@health.mo.gov. ONE ATTACHMENT

Reorganization of WIC Reports Folders: On April 1, 2008, the WIC Reports folders will be reorganized. There will be approximately nine folders under the WIC Reports folder. All reports will be posted within one of these folders. Reports will be placed in the appropriate folder(s) according to the purpose or use of the report. If a report belongs in more than one folder, a shortcut will be placed in each folder for that report. The main folders will be: Caseload Management, Clinic Management, Fiscal Management, FI Accountability/Reconciliation, Nutrition Services, Planning/Evaluation, TA/Desk Audit/Monitoring, WIC Vendor, Farmers Market. A Table of Contents (TOC) folder will also be available. Please check the TOC for the location of the reports beginning April 1, 2008. The TOC will no longer contain a description of the report itself. The description of each report is under the report name in the appropriate folder.

HANDS Help Desk and Cathy Propst: Cathy Propst, the state WIC person you usually talk to on the HANDS Help desk is leaving to go to the Missouri Department of Transportation as a Project Manager with the Information Systems Division. Her last day with the state WIC office will be March 31, 2008. Please join us in wishing Cathy the best in her new endeavor. Other staff will cover the Help Desk after Cathy leaves. Continue to use WICHelpDesk@health.mo.gov when you have email for the Help Desk.

Required LWP Information on the WIC ID Folders: Per the request of participants who want to contact their local agency, all Local WIC Providers are strongly encouraged to place contact information on the WIC ID folder. Many agencies already do this but not all. Having the agency’s information on the ID folder will make it easier for vendors to return the ID folder if it is left at the store. The information may be stamped or affixed as a label to the front (recommended) or inside of the folder in an area without any printing and should include at least the Agency or Clinic Name, Address and a Contact Phone Number. Clinic hours and satellite information are optional.

State WIC Staff Pictorial Directory: The State WIC office has updated its pictorial directory of State agency staff. Each staff person in the State office is pictured with their title, a brief description of their area of responsibility and telephone number. Since we do not always have the opportunity to meet each other face to face, we hope this will help you put a name to a face when you call our office. If you have any questions, please contact Barbara Myers at Barbara.Myers@health.mo.gov.

Save the Date: WIC June 2008 Program Updates Training has been scheduled. Please see the attached sheet for the dates and locations. The training will address the following topics:
- WIC Approved Food List - Effective October 1, 2008.
- New and Improved Cereals (Health Benefits & Education Resources)
- Food Package Changes

This training is mandatory for all local WIC providers. At least one CPA (Train-the-Trainer) from each local WIC provider must attend. More information will be announced through WIC UPDATE. If you have suggestions or questions, please contact Takako Tagami at Takako.Tagami@health.mo.gov. ONE ATTACHMENT

[Note] A Tri Monthly Orientation session will be held for local WIC providers who have not participated in the Tri-Monthly Pilot.

Loving Support Partnering with WIC for Breastfeeding Success Video: Breastfeeding Coordinators will be receiving in the mail the DVD "Loving Support: Partnering with WIC for Breastfeeding Success". The target audiences for this video are health care providers, health care organizations, policy makers, and other stakeholders that promote and support breastfeeding. WIC participants are not the target audience for this project. We encourage you to use this video as you continue to promote and support breastfeeding through your community outreach efforts. Feel free to make copies of the video or you may order additional copies at no charge from the state WIC office. An order form is included with the DVD. If you have any questions, please contact Kathy Mertzlufft at Kathy.Mertzlufft@health.mo.gov or by telephone at 573-526-4792.

Breast Pump Order: In about two weeks, Medela will begin shipping the Lactina Select electric and Harmony manual breast pumps and the double pumping kits. Most of the local agencies that ordered these items should receive shipment around the first week of April. A few agencies that ordered a large quantity of the Lactina Selects will not receive them until mid-April.
Please remember that the following procedure must be followed in order to verify receipt of shipment for payment and to send the required WIC tags.
- Immediately upon receipt of shipment, please locate the packing slip and verify your agency received the products and quantities stated.
- Sign the packing slip to verify the order is correct.
- Fax the signed packing slip to Michael Murphy at the state WIC office at 573-526-1470. WIC tags will be mailed upon receipt of your packing slip.
- If your agency did not receive what was stated on the packing slip, please contact the state WIC office immediately.
If you have any questions, please contact Kathy Mertzlufft at Kathy.Mertzlufft@health.mo.gov or by telephone at 573-526-4792.

Extra Formula: A database listing unused infant formulas and medical foods is kept at the State WIC Office. With the implementation of the approval authority for many infant formulas and medical foods now at the local level, the State Office may not always know what is available in the local agencies. Please check the listing to utilize formulas with the most recent expiration date first, prior to placing an order, to help keep food costs down.
Attached is a current listing of extra formula available at different LWPs and guiding principles for shipping created to assist you when sending or receiving extra supply of infant formula. Please be sure to notify your district nutritionist or D'Anne Ward when you have unused formula available at your agency so it may be added to the database. If you have any questions regarding this information, please contact D'Anne Ward at 1-800-392-8209 or email danne.ward@health.mo.gov THREE ATTACHMENTS

VENA Nutrition Committee February 25 Meeting Minutes: The VENA Nutrition Committee had their most recent meeting on February 25. The meeting minutes and list of committee members are attached. The committee will be meeting or having a conference call on a monthly basis with the next meeting/conference call scheduled for March 24. If there are issues you would like to discuss with any of the committee members, the attached includes contact information. TWO ATTACHMENTS

Missouri WIC Income Guidelines April 1, 2008- March 31, 2009: The Income Guidelines for April 1, 2008 - March 31, 2009 are attached. These are draft guidelines pending approval from USDA. If you have any questions, please contact Glenn Studebaker, glenn.studebaker@health.mo.gov or 573-751-6198. Once the guidelines are approved, we will be printing and laminating these for your use and will mail them to you once the laminated copies become available. ONE ATTACHMENT

Income Changes in HANDS: Effective April 14, 2008, there will be changes made in HANDS concerning the income and missing proof of eligibility. The income will be keyed on the H201/H202 screens and there is now a new field on those screens as well for missing proof.

The missing proof field is answered with a Y (yes) or N (no), meaning he/she is missing one or more of the three required proofs. By keying a Y in this field, the system will only allow one month of FIs (the month of the service date) and there is no longer a need to key the "P" food package into the food package code field.

Once the participant returns in 30 days with their missing proof, simply go to the H202 screen and key N (no) in the missing proof field. If the income dollar amount ($) needs to be changed, key that as well. Then print FIs.

There is also a question that you will see on the H202 screen. The question is necessary for "behind the scenes" programming and keeping the data in sync. The question asks if you will be keying a new cert (H401/H421) or recert (H402/H422) screen after you key this H202 screen. If you will be keying one of the four screens, key a Y to answer the question. If you will not be keying one of the four screens (such as a 30-day follow-up), key N to answer the question.

Also, the Med Elig field has been removed from the H400 cert/recert screens.

Please refer to the screen shots attached to view the new/changed fields.

If you have questions, please contact the WIC Help desk at 800-554-2544 or Melissa Seaver at 573-751-6489.